Provider Demographics
NPI:1720758303
Name:GOOD CARE MED LLC
Entity Type:Organization
Organization Name:GOOD CARE MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:862-371-9004
Mailing Address - Street 1:374 CHESTNUT ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2495
Mailing Address - Country:US
Mailing Address - Phone:973-902-3116
Mailing Address - Fax:
Practice Address - Street 1:374 CHESTNUT ST STE A
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2495
Practice Address - Country:US
Practice Address - Phone:973-902-3116
Practice Address - Fax:580-297-9263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFO0206575OtherDEA